title: [Persistent polyclonal B-cell lymphocytosis: study of 35 cases].
abstract: OBJECTIVE
  Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare entity, presenting especially in adult smoker women. It is characterized by an increase of serum IgM, DR7-HLA haplotype, cytogenetic abnormalities and multiple IgH/BCL-2 rearrangements. To date, it has not been elucidated whether this is a benign or premalignant disorder. We analyzed the PPBL characteristics with especial attention to its evolution.
  
  
  METHODS
  Thirty-five PPBL patients from 5 hospitals in Catalonia were retrospectively analyzed. A simultaneous morphologic review of the blood smears was performed by members of the GCCH in a 16 multiple-observer optic microscope. Clinical and biological data were also analyzed.
  
  
  RESULTS
  PPBL presents in the majority of cases with persistent polyclonal B-cell lymphocytosis and affects primarily smoker women. The morphologic hallmark, in absence of viral infections, is the presence of activated lymphocytes with bilobulated and/or cleaved nuclei, and nuclear pockets in the ultrastructural study. Increased serum IgM, HLA-DR7 haplotype, chromosomal abnormalities such as i(3)(q10) and multiple IgH/BCL-2 rearrangements were detected. Thirty-four out of 35 patients are alive after a median follow up of 70.7 months. One patient died because of lung adenocarcinoma and another developed a follicular lymphoma without relation to PPBL.
  
  
  CONCLUSIONS
  PPBL has an asymptomatic and stable evolution, although it frequently presents genetic abnormalities. It remains unknown whether it is a premalignant entity, similar to monoclonal gammopathies of unknown significance. Hence, accurate cytologic diagnosis and follow-up are essential.
authors.affiliation: Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, España. lflorensa@imas.imim.es
authors.forename: Lourdes
authors.initials: L
authors.lastname: Florensa
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Navarro
authors.forename: María Encarnación
authors.initials: ME
authors.lastname: Pérez Vila
authors.forename: Alicia
authors.initials: A
authors.lastname: Domingo
authors.forename: Esmeralda
authors.initials: E
authors.lastname: De la Banda
authors.forename: Maria
authors.initials: M
authors.lastname: Rozman
authors.forename: Mireia
authors.initials: M
authors.lastname: Camós
authors.forename: Fuensanta
authors.initials: F
authors.lastname: Millá
authors.forename: Granada
authors.initials: G
authors.lastname: Perea
authors.forename: Esther
authors.initials: E
authors.lastname: Alonso
authors.forename: Ramon
authors.initials: R
authors.lastname: Ayats
authors.forename: Ana
authors.initials: A
authors.lastname: Aventín
authors.forename: Elena
authors.initials: E
authors.lastname: Cabezudo
authors.forename: Blanca
authors.initials: B
authors.lastname: Espinet
authors.forename: Ana
authors.initials: A
authors.lastname: Merino
authors.forename: Pilar
authors.initials: P
authors.lastname: Romero
authors.forename: Carmen
authors.initials: C
authors.lastname: Sánchez
authors.forename: Esperanza
authors.initials: E
authors.lastname: Tuset
authors.forename: Francesc
authors.initials: F
authors.lastname: Solé
authors.forename: Evarist
authors.initials: E
authors.lastname: Feliu
authors.forename: Cristalina
authors.initials: C
authors.lastname: Fernández
authors.forename: Miquel
authors.initials: M
authors.lastname: Gallart
authors.forename: Teresa
authors.initials: T
authors.lastname: Vallespí
authors.forename: Soledad
authors.initials: S
authors.lastname: Woessner
mesh_terms: D000328:Adult; D001402:B-Lymphocytes / Q000378:metabolism / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008213:Lymphocyte Activation; D008218:Lymphocytosis / Q000235:genetics / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000276:immunology*; D012189:Retrospective Studies; D017678:Sex Distribution; D012907:Smoking